Stabilization of endoscopic equipment during a procedure may be desirable under a variety of circumstances. Colonoscopy is made easier by a stand that supports the weight of the scope, which allows for increased freedom of the hands for manipulation. Surgical manipulation during laparoscopy also is aided by stabilizing the instruments. Other instrument holders have been devised to keep endoscopic instruments untangled and secure on or near the operating table.
In urological practice ureteral catheter or stent placement and routine stone manipulation are facilitated by endoscopic stabilization. A stable cystoscope decreases, radiation exposure to the physician who performs retrograde pyelography by increasing the distance from the radiation source during injection of the contrast agent. Photography is aided by anchoring the cystoscope, as well as visualization of pathological conditions by a succession of students, residents or colleagues. Photodynamic therapy, in which constant light distribution to the bladder mucosa during several minutes is necessary, requires stabilization of the cystoscope.
Several means have been used to stabilize endoscopic equipment, including a variety of stationary adjustable stands and flexible coiled instruments. When no cystoscope holder is available a sling constructed from a surgical towel has been used. Most of these devices are less than ideal because they frequently are awkward or only transiently stable.
Thus, the stabilization of an endoscope during an examination procedure or a retractor during surgery is frequently necessary and presents problems for the physician or surgeon. Most attempts to support endoscopes require holders and supporting arrangements which restrict the physician's mobility to manipulate the instrument to desired locations once the instrument has been positioned. The same problems exist with other instruments, including retractors, during surgery. Over the years, many attempts have been proposed in the patent literature to overcome this cumbersome problem of stability. For example, the U.S. Pat. Nos. 4,457,300 to Budde and 4,573,452 to Greenberg disclose surgical holders for supporting retractors and laparoscopes, respectively. Both of these holders utilize flexible supporting posts or arms for facilitating some movement of the medical equipment during the respective procedures. However, while these flexible posts or arms permit movement of the particular instruments, neither of these holders employ clamps with a sufficient degree of movement and/or rotation and which can accept instruments therein without considerable difficulty. Thus, while these devices are useful, they nevertheless restrict the ease with which a surgeon or physician can mount the instrument to the support once use of the instrument has begun.
The patent to Greenberg employs a clamp 70 at the distal end of the flexible member 60 through which, apparently, the laparoscope 10 must be threaded prior to use thereof (See col. 4, lines 28-33). In other words, the clamp 70 does not easily permit subsequent attachment to the laparoscope after the laparoscope has been positioned within the abdomen. In practice, however, it is very inconvenient to try to manipulate such an instrument, or a cystoscope or retractor, with extraneous equipment affixed to or near the proximal end, and invariably the surgeon or physician will first try to manipulate the instrument while it is unencumbered and then later try to clamp it into position, which apparently cannot be done with the Greenberg construction.
Other types of clamps having movable jaws have the tendency to crush or damage the instrument which it is trying to support, and this is especially likely when actions must be taken quickly. This leads to the damage or destruction of some very expensive instruments. In some cases clamps for such instruments can be used for instruments of only one diameter. Also, prior devices have limited degrees of movement or rotation. Patent literature showing such other clamps for surgical instruments and retractors include the patents to Grieshaber 3,040,739; Gauthier 3,384,077; Fackler 4,461,284 and LeVahn et al 4,617,916, but these constructions have not solved the aforementioned problems.
Other clamps have been designed for special purposes, such as for supporting tubular members without the necessity of using rotatable lever/movable jaw structures. For example, the U.S. Pat. Nos. 2,061,718 to Stahl; 2,482,625 to Kunkel; 4,616,384 to Lowell et al and 4,616,797 to Cramer all show adjustable clamps using spring-biased members to urge the device to be supported against or within a channel cavity. The Patents to Stahl, Cramer, and Lowell et al all require the use of turnable knobs or levers to aid in the manipulation of the clamp. The Kunkel clothes pin has a proximal jaw, spring-biased to the fully closed position relative to its distal jaw and must be urged open to accept a device to be clamped. These above-mentioned patents are neither designed nor suited for holding delicate and expensive surgical instruments.
No surgical instrument holder and clamp therefor has previously been available for holding cystoscopes or other endoscopic devices or surgical retractors that may be attached readily and locked or anchored in place after positioning relative to the patient, and which also may accommodate various sized instruments. There is a great need for a surgical holder having a clamp of greater versatility during endoscopic and surgical procedures, and which will allow for a firm but delicate grasp of fiber optic instruments and which will facilitate instrument rotation of 360 degrees along two axes.